Healthcare Provider Details

I. General information

NPI: 1447683891
Provider Name (Legal Business Name): RIKKI RENEA VIGIL CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7019 S KNOLLS WAY
CENTENNIAL CO
80122-1732
US

IV. Provider business mailing address

7019 S KNOLLS WAY
CENTENNIAL CO
80122-1732
US

V. Phone/Fax

Practice location:
  • Phone: 970-445-8137
  • Fax:
Mailing address:
  • Phone: 970-445-8137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0012925
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: